Opinion
NOT TO BE PUBLISHED IN OFFICIAL REPORTS
APPEAL from a judgment of the Superior Court of San Diego County No. MH100488, Robert P. Ahern, Judge.
McDONALD, Acting P. J.
Conservatee Brenda P. (Brenda) appeals a judgment finding her gravely disabled as defined in Welfare and Institutions Code section 5008, subdivision (h)(1)(A), appointing a conservator for her, and ordering her placed in a closed, locked facility as the least restrictive level of placement available and necessary to achieve the purpose of her treatment. On appeal, she contends: (1) the trial court abused its discretion by considering, as a factor in deciding her placement, that the conservator could change her placement pursuant to section 5358, subdivision (d)(1) without court approval; and (2) the evidence is insufficient to support the court's finding that a closed, locked facility is the least restrictive level of placement.
All statutory references are to the Welfare and Institutions Code.
FACTUAL AND PROCEDURAL BACKGROUND
On November 15, 2006, Kathryn A. Grant, the Public Conservator of San Diego County (Conservator), filed a petition to establish a conservatorship for Brenda pursuant to section 5354 of the Lanterman-Petris-Short (LPS) Act (§ 5350 et seq.). The petition alleged Brenda was 28 years old and undomiciled.
Brenda admitted she had a mental disorder, described as schizoaffective disorder of a bipolar type, but denied that disorder prevented her from providing for her personal basic needs of food, clothing, or shelter.
A jury trial was conducted on the issue of whether Brenda was gravely disabled as a result of a mental disorder making her unable to provide for her basic personal needs for food, clothing, or shelter. At trial, Yashwant Chaudhri, a staff psychiatrist at Scripps Memorial Hospital, testified he had treated Brenda for the past two months after her admission as a hospital inpatient and had seen her daily during that period (except for a few days). She had six emergency room visits and four psychiatric hospitalizations within the past year. Chaudhri diagnosed her condition as schizoaffective disorder of a bipolar type. Brenda had paranoid delusions, including auditory hallucinations, and mood disturbance (i.e., alternating depression and hypomania/elation). She believed she was pregnant when she was not.
Her mental illness began when she was 18 years old and in college. Although she had been inconsistent in taking her prescribed medication, she had done well in the past when in a structured setting, (e.g., as a long-term hospital inpatient). When in a structured setting, she takes her medication consistently and regularly receives psychotherapy and group therapy, which improves the quality of her life. Her medication stabilizes her mood and thinking. When she is in a nonstructured setting (e.g., a board and care facility or independent living facility), she has been unable to follow the facility's guidelines and has been inconsistent with her treatment (e.g., taking her medication). Drug and alcohol abuse has also significantly compromised the quality of her life. She attempted suicide five times, showing there may be a future suicide risk. During one suicide attempt, she jumped off a bridge and sustained multiple fractures to her neck, back, and pelvic bones.
Chaudhri testified that Brenda could not provide for her basic personal needs for food, clothing, or shelter. Although she received monthly social security payments, she was unable to budget her money and spent it soon after she received it. Out of the jury's presence, Chaudhri testified that Brenda was unable to make decisions regarding treatment of her disorder because she did not completely understand it. He believed the least restrictive placement for her was currently in the psychiatric hospital and, on her discharge, in a long-term, locked placement, such as the Alpine Treatment Center. He believed she should not be placed in a board and care facility at the present time, although he possibly may recommend it in the future.
Dawn Salmons, a social worker at Brenda's hospital, testified her duties included patient discharge planning in the psychiatric inpatient unit. A patient's income, medication compliance, history (e.g., length of stay at prior facilities), and the recommendation of the patient's doctor are factors she considers in determining a patient's placement. In June 2006, Salmons placed Brenda at an independent living facility. Brenda was hospitalized two weeks later because she was suicidal. She later returned to that facility, but was evicted in October and was soon hospitalized again. Brenda had been evicted because she was not taking her medications, did not follow the facility's rules, and did not get along with the other residents (e.g., fought with them). Within the past few weeks while hospitalized, Brenda reported that she was pregnant, but a pregnancy test showed she was not. She also walked naked down the hospital's hallway and refused to put on clothing. Salmons agreed with the doctor's decision that Brenda would not be successful in a board and care facility and should be placed in a locked facility.
Glennis P. (Glennis), Brenda's mother, testified that Brenda's condition was first diagnosed as schizophrenia when she was in college. When Brenda is ill (i.e., untreated), she screams all night and is verbally abusive to her family. Brenda's most common delusion is that she is pregnant and about to have a baby any minute, often demanding that she be driven immediately to a hospital. Brenda also has the delusion that Glennis is not her biological mother and stole her from someone who really cared for her. Pursuant to a prior conservatorship, Brenda was placed in the Alpine Treatment Center, a long-term facility, where she did quite well. After she left, she started "going downhill" again while in a board and care facility.
Brenda testified that she had a mental disorder. She wanted Glennis prosecuted for stealing her from her "real" mother and father before she could walk. Brenda remembered being taken from a hospital and placed in a trunk. Brenda demanded a DNA test to prove Glennis was not her true mother. Brenda testified Glennis had murdered one of Brenda's friends. She also testified that she was currently six or seven months pregnant and intended to raise her child.
The jury returned a unanimous verdict, finding that Brenda has a mental disorder and that "[a]s a result of this mental disorder, Brenda . . . is unable to provide for her basic personal needs for food, clothing, or shelter. [¶] Thus, Brenda . . . is presently gravely disabled." The trial court then heard arguments of counsel regarding the least restrictive placement for Brenda. The court concluded she should be placed in a closed, locked facility at this time.
On December 22, 2006, the court entered a judgment establishing a one-year conservatorship for Brenda, appointing the Conservator as her conservator, and ordering a closed, locked facility as the least restrictive placement available and necessary to achieve the purpose of her treatment.
Brenda timely filed a notice of appeal.
DISCUSSION
I
Trial Court's Consideration of the Conservator's Authority under the LPS Act
Brenda contends the trial court abused its discretion when, in determining the least restrictive placement for her, it considered as a factor how the Conservator under the LPS Act could transfer her to either a less restrictive or more restrictive placement than ordered by the court.
A
The LPS authorizes "the appointment of a conservator for up to one year for a person determined to be gravely disabled as a result of a mental disorder and unable or unwilling to accept voluntary treatment." (Conservatorship of Susan T. (1994) 8 Cal.4th 1005, 1009, fn. omitted.) One of the goals of the LPS Act is "providing individualized treatment, supervision and placement services for the gravely disabled by means of a conservatorship program." (Ibid.) Under one definition, "gravely disabled" means "[a] condition in which a person, as a result of a mental disorder, is unable to provide for his or her basic personal needs for food, clothing, or shelter." (§ 5008, subd. (h)(1)(A).) When a conservatee is "gravely disabled" under that definition, the court must order the conservatee to be placed "in a suitable facility as close as possible to his or her home or the home of a relative" (if the conservatee is not placed in his or her home or the home of a relative). (§ 5358, subd. (c)(1).) A "suitable facility" means "the least restrictive residential placement available and necessary to achieve the purpose of treatment." (§ 5358, subd. (c)(1).) "After considering all the evidence the court shall determine the least restrictive and most appropriate alternative placement for the conservatee." (§ 5358, subd. (c)(1).) A conservator shall place his or her conservatee in the least restrictive placement designated by the court. (§ 5358, subd. (a)(1)(A).) However, a conservator has authority under the LPS Act to transfer the conservatee to a less restrictive or more restrictive placement than ordered by the court:
"[T]he conservator may transfer his or her conservatee to a less restrictive alternative placement without a further hearing and court approval. In any case in which a conservator has reasonable cause to believe that his or her conservatee is in need of immediate more restrictive placement because the condition of the conservatee has so changed that the conservatee poses an immediate and substantial danger to himself or herself or others, the conservator shall have the right to place his or her conservatee in a more restrictive facility or hospital. . . . [I]f the change of placement is to a placement more restrictive than the court-determined placement, the conservator shall provide written notice of the change of placement and the reason therefor to the court, the conservatee's attorney, the county patient's rights advocate and any other persons designated by the court pursuant to subdivision (c)." (§ 5358, subd. (d)(1).)
B
After the jury returned its verdict, the trial court discussed with counsel the issue of the least restrictive placement for Brenda, as follows:
"[Conservator's counsel]: . . . [B]ased on the recommendation of the doctor, or treating psychiatrist, we would ask that the least restrictive level of placement be a closed-level, locked facility.
"The Court: Response?
"[Brenda's counsel]: Your Honor, we would object. We believe the evidence has shown, first of all, [Brenda] has been in a closed, locked facility for about 60 days now. All the evidence has shown is that she's in a more stable condition now than she was when she entered the facility. [¶] The evidence has further shown that she's done very well in a board and care. They regulate her medication, provide her food and shelter. We believe the appropriate level of placement at the present time is a board and care, not a closed [and] locked[,] facility.
"[The Court:] The question for the record then must be can or could [Brenda] be moved to a lesser restrictive placement without further court order if I were to order a closed, locked facility at this time[?]
"[Conservator's counsel]: And the answer is yes, your Honor.
"The Court: Response?
"[Brenda's counsel]: And the answer is also that if a board and care doesn't work out, the [Conservator] could simply come in and request that she be placed in a closed, locked facility.
"The Court: That precipitates another question. Logically, I don't know if that follows if the order is in existence for [a] closed, locked facility. I am hearing she could be moved down without further court order. And if the court order is still in effect, I would think logically she could move back to a closed, locked facility if it's appropriate. [¶] But if I order a board and care now, she could not be placed in a locked facility without coming back to court for further hearing[,] is that correct?
"[Conservator's counsel]: That's correct, your Honor.
"[Brenda's counsel]: I believe that is correct."
The court then stated: "Based on everything I heard, the court is going to make the order for a closed, locked facility at this time."
C
Brenda argues the trial court, in determining the least restrictive placement for her, considered how easily the Conservator under the LPS Act (i.e., § 5358, subd. (d)(1)) could transfer her to a less restrictive or more restrictive placement than ordered by the court. In so doing, she argues the court abused its discretion by not restricting its consideration of the issue of the least restrictive placement to only those factors set forth in section 5358, subdivision (c)(1). She argues the trial court should have restricted its consideration to only those factors relevant to determining "the least restrictive residential placement available and necessary to achieve the purpose of treatment." (§ 5358, subd. (c)(1).)
The record shows the trial court addressed the statutory authority of the Conservator under the LPS Act to transfer Brenda to either a less restrictive or more restrictive placement than ordered by the court. In so doing, the court did not, however, abuse its discretion. Rather, it simply confirmed the Conservator's statutory authority under section 5358, subdivision (d)(1). Both counsel agreed the court accurately described that statutory authority of a conservator to transfer a conservatee to a less or more restrictive placement than ordered by the court. Unlike Conservatorship of Amanda B. (2007) 149 Cal.App.4th 342, cited by Brenda, the trial court in this case made a decision on the least restrictive placement for her (i.e., a closed, locked facility) and did not delegate that decision to the Conservator. (Id. at pp. 345, 352-353.) In Amanda B., we stated: "The trial court in this case did not designate the level of placement, but rather, offered two options from which the conservator was to choose. It is clear that the trial court was not simply reaffirming the discretion given to the conservator to place Amanda in a less restrictive alternative placement once she no longer required the restrictions of a locked facility." (Id. at p. 353, italics added.) Unlike Amanda B., in this case the trial court essentially "reaffirmed" the statutory authority of the Conservator to transfer Brenda to a less restrictive placement in the event she (in the future) no longer requires the locked facility ordered by the court. (Ibid.)
The record does not show the trial court ordered Brenda placed in a closed, locked facility because the Conservator had that statutory authority, rather than because that placement was the "the least restrictive residential placement available and necessary to achieve the purpose of treatment." (§ 5358, subd. (c)(1).) Brenda argues the court's questions of counsel regarding the Conservator's statutory authority to transfer her to a less or more restrictive facility shows it must have considered that authority in deciding to order her placed in the more restrictive facility (i.e., a closed, locked facility) and, on such consideration, chose the more restrictive facility rather than the placement that best suited her treatment needs. However, we conclude the record does not support that argument. On appeal, all intendments and presumptions are indulged to support the judgment. (Denham v. Superior Court (1970) 2 Cal.3d 557, 564.) Furthermore, we presume the trial court followed the law. (Wilson v. Sunshine Meat & Liquor Co. (1983) 34 Cal.3d 554.) Therefore, because the record does not affirmatively show the trial court decided to order Brenda placed in a closed, locked facility based on the Conservator's statutory authority to transfer her to a less restrictive facility rather than on the least restrictive residential placement available and necessary to achieve the purpose of treatment, we conclude the trial court properly followed the law and considered only those factors permitted by section 5358, subdivision (c)(1). We conclude the trial court decided to order that Brenda be placed in a closed, locked facility because it is the least restrictive residential placement available and necessary to achieve the purpose of treatment and not because the court chose to essentially delegate to the Conservator the court's task of selecting her placement.
Northington v. Davis (1979) 23 Cal.3d 955 and In re Marriage of Loyd (2003) 106 Cal.App.4th 754 are inapposite and do not persuade us to conclude otherwise.
To the extent the court did consider the statutory framework of the LPS Act, including the Conservator's authority under section 5358, subdivision (d)(1) while deciding the least restrictive residential placement available and necessary to achieve the purpose of Brenda's treatment, we conclude the court did not err. A court may consider relevant law in deciding which placement is the least restrictive placement necessary to achieve the purpose of a conservatee's treatment. Although section 5358, subdivision (d)(1) presumably grants a conservator broader authority to transfer a conservatee to a less restrictive facility (and then potentially back to a more restrictive facility, if necessary) than to transfer a conservatee to a more restrictive facility from an initial less restrictive facility, that broader authority, and/or a court's recognition of that authority, does not, as Brenda argues, "predispose" a court to choose the more restrictive placement instead of the least restrictive residential placement available and necessary to achieve the purpose of a conservatee's treatment. The court did not abuse its discretion by recognizing the Conservator's authority under section 5358, subdivision (d)(1). Brenda has not carried her appellate burden to show the trial court applied the wrong legal standard in determining her placement. (Cf. Conservatorship of Scharles (1991) 233 Cal.App.3d 1334, 1340.)
II
Substantial Evidence to Support Placement Decision
Brenda contends the evidence is insufficient to support the trial court's decision to place her in a closed, locked facility as the least restrictive placement available and necessary to achieve the purpose of her treatment.
Brenda does not contend on appeal there is insufficient evidence to support the jury's finding that she is gravely disabled.
A
When an appellant challenges the court's findings based on a purported lack of sufficient evidence to support those findings, we apply the substantial evidence standard of review. (Bickel v. City of Piedmont (1997) 16 Cal.4th 1040, 1053, superseded by statute on another ground as noted in DeBerard Properties, Ltd. v. Lim (1999) 20 Cal.4th 659, 668; Thompson v. Tracor Flight Systems, Inc. (2001) 86 Cal.App.4th 1156, 1166.) In applying the substantial evidence standard of review, we "view the evidence in the light most favorable to the prevailing party, giving it the benefit of every reasonable inference and resolving all conflicts in its favor . . . ." (Jessup Farms v. Baldwin (1983) 33 Cal.3d 639, 660.) "It is not our task to weigh conflicts and disputes in the evidence; that is the province of the trier of fact. Our authority begins and ends with a determination as to whether, on the entire record, there is any substantial evidence, contradicted or uncontradicted, in support of the judgment. Even in cases where the evidence is undisputed or uncontradicted, if two or more different inferences can reasonably be drawn from the evidence[,] this court is without power to substitute its own inferences or deductions for those of the trier of fact, which must resolve such conflicting inferences in the absence of a rule of law specifying the inference to be drawn. . . . [Citations.]" (Howard v. Owens Corning (1999) 72 Cal.App.4th 621, 631.) "[E]ven if the judgment of the trial court is against the weight of the evidence, we are bound to uphold it so long as the record is free from prejudicial error and the judgment is supported by evidence which is 'substantial,' that is, of ' "ponderable legal significance," ' ' "reasonable in nature, credible, and of solid value . . . ." ' [Citations.]" (Ibid.) The testimony of a single witness may constitute substantial evidence. (In re Marriage of Mix (1975) 14 Cal.3d 604, 614.) Nevertheless, substantial evidence " 'is not synonymous with "any" evidence.' " (Roddenberry v. Roddenberry (1996) 44 Cal.App.4th 634, 651.)
"Moreover, we defer to the trier of fact on issues of credibility. [Citation.] '[N]either conflicts in the evidence nor " 'testimony which is subject to justifiable suspicion . . . justif[ies] the reversal of a judgment, for it is the exclusive province of the [trier of fact] to determine the credibility of a witness and the truth or falsity of the facts upon which a determination depends.' " [Citations.] Testimony may be rejected only when it is inherently improbable or incredible, i.e., " 'unbelievable per se,' " physically impossible or " 'wholly unacceptable to reasonable minds.' " [Citations.]' [Citation.]" (Lenk v. Total-Western, Inc. (2001) 89 Cal.App.4th 959, 968.)
"Inferences may constitute substantial evidence, but they must be the product of logic and reason. Speculation or conjecture alone is not substantial evidence. [Citations.]" (Roddenberry v. Roddenberry, supra, 44 Cal.App.4th at p. 651.) Furthermore, " '[w]here different inferences may reasonably be drawn from undisputed evidence, the conclusion of the jury or trial judge must be accepted by the appellate court.' " (In re Providian Credit Card Cases (2002) 96 Cal.App.4th 292, 301.) "The ultimate test is whether it is reasonable for a trier of fact to make the ruling in question in light of the whole record. [Citation.]" (Roddenberry, at p. 652.)
B
Applying the substantial evidence standard of review to this case, we conclude there is substantial evidence to support the trial court's decision that a closed, locked facility is the least restrictive residential placement available and necessary to achieve the purpose of Brenda's treatment. Of most import, Chaudhri, Brenda's hospital psychiatrist, testified that the least restrictive placement for Brenda was currently in the psychiatric hospital and, on her discharge, in a long-term, locked placement, such as the Alpine Treatment Center. He believed she should not be placed in a board and care facility at the present time, although he may possibly recommend it in the future. Contrary to Brenda's assertion, Chaudhri's opinion was not conclusory, but rather was implicitly (if not expressly) based on his treatment of her for the past two months and his review of her medical records, including information regarding her past experiences in various living situations. Before stating his opinion regarding the least restrictive placement for Brenda, Chaudhri testified she had six emergency room visits and four psychiatric hospitalizations within the past year.
Brenda has a schizoaffective disorder of a bipolar type with paranoid delusions, including auditory hallucinations, and mood disturbance (i.e., alternating depression and hypomania/elation). When in a structured setting (e.g., as a hospital inpatient), she consistently takes her medication, which stabilizes her mood and thinking. When in a nonstructured setting (e.g., a board and care facility or independent living facility), she has been unable to follow the facility's guidelines and has been inconsistent with her treatment (e.g., taking her medication). In recommending the least restrictive placement for Brenda, Chaudhri was not required to restate all of his prior testimony regarding Brenda's disorder and medical and living history to support that conclusion. Although he may not have then expressly explained why Brenda needed to be in a closed, locked facility, his prior testimony regarding her history showed she consistently took her medication only when she was in a structured setting (i.e., a closed, locked facility) and not when she was in a less restrictive or nonstructured setting such as a board and care facility. Chaudhri's testimony constituted substantial evidence to support the trial court's decision that a closed, locked facility is the least restrictive residential placement available and necessary to achieve the purpose of Brenda's treatment. (In re Marriage of Mix, supra, 14 Cal.3d at p. 614 [testimony of a single witness may constitute substantial evidence].)
Jennings v. Palomar Pomerado Health Systems, Inc. (2003) 114 Cal.App.4th 1108, People v. Bassett (1968) 69 Cal.2d 122 and Pacific Gas & Electric Co. v. Zuckerman (1987) 189 Cal.App.3d 1113, cited by Brenda, are inapposite and do not persuade us to conclude otherwise.
The record also includes testimony from other witnesses that provides additional support for the trial court's decision. Salmons, Brenda's hospital social worker, testified regarding Brenda's placement history and agreed with Chaudhri's decision that Brenda would not be successful in a board and care facility and should be placed in a locked facility. Glennis testified regarding Brenda's past delusions and her placement history. Glennis noted that pursuant to a prior conservatorship, Brenda was placed in the Alpine Treatment Center, a long-term facility, where she did quite well. However, after she left, she started "going downhill" again while in a board and care facility. The testimonies of Salmons and Glennis provide additional support for the trial court's decision that a closed, locked facility (and not a board and care facility) is the least restrictive residential placement available and necessary to achieve the purpose of Brenda's treatment. Based on the testimonies of Chaudhri, Salmons, and Glennis and the other evidence in the record, we conclude there is substantial evidence to support the trial court's decision that a closed, locked facility is the least restrictive residential placement available and necessary to achieve the purpose of Brenda's treatment. Although, as Brenda argues, there may have been other evidence that could have supported a different decision (e.g., that a board and care facility is the least restrictive facility), the existence of evidence supporting a different decision does not show the evidence is insufficient to support the trial court's decision. (Howard v. Owens Corning, supra, 72 Cal.App.4th at p. 631.)
Although Brenda, in her reply brief, apparently argues the testimonies of Salmons and Glennis could not provide support for the trial court's decision because neither was an expert (e.g., psychiatrist), Brenda does not cite, and we are unaware of, any authority holding that a trial court can consider only expert testimony in deciding the least restrictive residential placement for a conservatee under the LPS Act. On the contrary, we believe it is incumbent on a trial court to consider the entire record, including testimony regarding a conservatee's past behavior and success in past placements, in determining that question.
DISPOSITION
The judgment is affirmed.
WE CONCUR: AARON, J., IRION, J.